Extramedullary plasmacytoma of the ureter in an HIV-positive patient

International Cancer Conference Journal, May 2017

A 45-year-old Japanese man, who was undergoing HIV infection treatment, was aware that he had gross hematuria, and he was diagnosed as having a ureteral tumor by radiographic examination. Therefore, he was referred to our department for further examination and treatment. We considered that the ureteral tumor was a urothelial carcinoma (cT2N0M0) because of the left ureteral tumor and urine cytology results, and thus, laparoscopic ureteronephrectomy was performed. The pathological diagnosis was a solitary extramedullary plasmacytoma (EMP) of the ureter. Currently, he is alive and free of disease at 7 months postoperatively. EMP develops in the nasal cavity, paranasal cavity, gastrointestinal tract, lung, thyroid, eye socket, lymph node, and various organs, but the ureter is an extremely rare site of EMP. In addition, the patient had an HIV infection. To the best of our knowledge, this is the first case of EMP of the ureter in an HIV-positive patient.

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Extramedullary plasmacytoma of the ureter in an HIV-positive patient

Int Canc Conf J Extramedullary plasmacytoma of the ureter in an HIV-positive patient Takashi Nagai 0 1 2 Takehiko Okamura 0 1 2 Yosuke Taki 0 1 2 Yutaro Tanaka 0 1 2 Daichi Kobayashi 0 1 2 Takahiro Kobayashi 0 1 2 Hidetoshi Akita 0 1 2 Takahiro Yasui 0 1 2 Ureter HIV 0 1 2 0 Abbreviations EMP Extramedullary plasmacytoma CT Computed tomography CK Cytokeratin 1 Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences , Nagoya , Japan 2 & Takehiko Okamura A 45-year-old Japanese man, who was undergoing HIV infection treatment, was aware that he had gross hematuria, and he was diagnosed as having a ureteral tumor by radiographic examination. Therefore, he was referred to our department for further examination and treatment. We considered that the ureteral tumor was a urothelial carcinoma (cT2N0M0) because of the left ureteral tumor and urine cytology results, and thus, laparoscopic ureteronephrectomy was performed. The pathological diagnosis was a solitary extramedullary plasmacytoma (EMP) of the ureter. Currently, he is alive and free of disease at 7 months postoperatively. EMP develops in the nasal cavity, paranasal cavity, gastrointestinal tract, lung, thyroid, eye socket, lymph node, and various organs, but the ureter is an extremely rare site of EMP. In addition, the patient had an HIV infection. To the best of our knowledge, this is the first case of EMP of the ureter in an HIV-positive patient. Extramedullary plasmacytoma infection - Department of Urology, Anjo Kosei Hospital, 28 Higashihirokute, Anjo-cho, Anjo, Aichi-ken 446-8602, Japan Introduction A plasmacytoma is a solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue. An extramedullary plasmacytoma (EMP) is less common than a solitary bone plasmacytoma, and it occurs when there is soft tissue infiltration of clonal plasma cells [ 1 ]. An EMP occurs in the nasal cavity, paranasal cavity, gastrointestinal tract, lung, thyroid, eye socket, lymph node, and various organs [ 1 ], but the ureter is an extremely rare site of EMP. We describe a patient with an EMP in the ureter who had an HIV infection. To the best of our knowledge, this is the first case of an EMP of the ureter in an HIV-positive patient. Case report A 45-year-old Japanese man receiving HIV infection treatment had gross hematuria. Since the ultrasound sonogram and computed tomography (CT) scan showed a left ureteral tumor (Fig. 1a), he was presented to our department for further examination and treatment. His medical history included condylomata acuminate of the penis, hepatitis B, and HIV infection. The HIV infection was well controlled with dolutegravir and emtricitabine/ tenofovir. He had no significant family, allergic, or smoking history. He received no blood transfusions. Serum laboratory findings showed an increased creatinine level (1.23 mg/dL; normal range \1.2 mg/dL) but no increase in tumor markers such as the squamous cell carcinoma antigen and cancer antigen 19-9. Results of urinalysis showed hematopyuria, and urine cytology findings were pseudopositive for urothelial carcinoma, of which few cells had a high nuclear-cytoplasmic ratio and their nuclei were hyperchromatic. On cystoscopy, no bladder tumor was observed. A whole-body CT scan was performed, and no distant metastasis or lymph node involvement was found. We also conducted retrograde unilateral left pyelography and a selective upper urinary cytology examination. The pyelogram showed the same left ureteral mass that was found on the CT scan. Results of the left upper urinary cytology examination were negative; there were few atypical cells, but their nuclei were not hyperchromatic. We diagnosed the ureteral tumor as a urothelial carcinoma (cT2N0M0) because of the left ureteral tumor and abnormal urine cytology findings, and laparoscopic ureteronephrectomy was performed. Macroscopically, a solid, papillary tumor, 30 mm in diameter, was observed in the upper side of the ureter (Fig. 1b). Histopathological findings included plasmacytoma-like atypical cells with a high nuclear-cytoplasmic ratio, perinuclear halo formation of invasion at the periureteral soft tissue of the ureter (Fig. 2a, b), and lymphocytic and histiocytic infiltration in the tumor. Invasion of the tumor cells was not observed in the pelvic mucosa or renal parenchyma. There was no component of urothelial carcinoma in the tumor or surrounding mucosa of the ureter. Immunohistochemical staining was performed to confirm the definitive diagnosis. Tumor cells were negative for cytokeratin (CK) 7, CK20, and p63 but positive for the markers of B cells or plasma cells, such as CD138 and CD79a/mb-1 (Fig. 2c). In addition, light chain restriction [immunoglobulin (Ig)c [ Igj] was observed (Fig. 2d). The final histopathological diagnosis was plasmacytoma not urothelial carcinoma. Fig. 2 a In the low-power field, tumors (asterisk) invade at least the periureteral soft tissue (hematoxylin and eosin (...truncated)


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Takashi Nagai, Takehiko Okamura, Yosuke Taki, Yutaro Tanaka, Daichi Kobayashi, Takahiro Kobayashi, Hidetoshi Akita, Takahiro Yasui. Extramedullary plasmacytoma of the ureter in an HIV-positive patient, International Cancer Conference Journal, 2017, pp. 171-174, Volume 6, Issue 4, DOI: 10.1007/s13691-017-0300-3